Parental Management of Young Children's Diabetes

Type 1 diabetes is a lifelong metabolic disorder that affects 1 out of every 400-600 American
children each year, with many children being diagnosed at younger and younger ages. If Type 1
diabetes is not properly controlled, it can lead to a host of devastating disease-related
complications later in life. Therefore, achieving proper diabetes control during childhood is
an important public health issue.

To achieve proper diabetes control, it is necessary to conform or adhere one's behavior to a
physician-prescribed diabetes self-care regimen consisting of multiple insulin
administrations and blood glucose (BG) checks daily, as well as pay careful attention to diet
and exercise. As such, parents of children with Type 1 diabetes must be highly involved in
managing their child's disease on a daily basis, especially parents of affected children who
are very young and more highly dependent upon parental caretaking.

It is not surprising that the experience of managing a child's diabetes can be demanding,
overwhelming, and stressful for some parents, and may even significantly impair parental
psychosocial well being. Further, difficulties achieving proper diabetes control have been
reported to occur among parents of children of all ages, including parents of those who are
very young.

Operationally, these psychosocial well being and diabetes outcomes can be examined by
assessing: (1) parental symptoms of depression, anxiety, diabetes parenting stress, and
perceived social support, and (2) metabolic control, which may be measured with the quarterly
HbA1C counts.

As children diagnosed with Type 1 diabetes at a very young age may be at an increased risk
for the development of long-term behavioral and medical complications due to the
aforementioned difficulties (on the part of their parents), more research is needed to
understand and treat the leading contributors to diabetes-related parental distress
(depression, anxiety, stress, social support) and medical outcomes among this growing
subgroup.

Recent findings indicate that responsibility for diabetes management falls heavily on
mothers, who report performing 79% of their children's injections and 70% of blood glucose
checks (Mednick, 2005). The majority of families do not receive outside child care assistance
and report feeling overwhelmed. Parents report high levels of pediatric parenting stress
difficulty, as well as moderate symptoms of anxiety. The current study aims to expand such
preliminary findings and specifically examine the effects of a newly-developed parenting
support program for parents of young children with Type 1 diabetes. The utility of the
intervention will be evaluated. It is hypothesized that parents completing the parent support
program will report lower levels of psychosocial distress and improved quality of life. It is
hypothesized that the children of participating parents will also demonstrate improved
quality of life and metabolic control.

Evaluating this intervention is a first step in the long-term goal of improving diabetes
health outcomes for young children. Understanding the usefulness of this intervention can
help us to further refine intervention programs for parents of young children with Type 1
diabetes that best meet their unique needs and risks.

Inclusion Criteria:

- Type 1 diabetes for at least 6 months prior to enrollment

- Seen for diabetes care at Children's National or Virginia Commonwealth

- Child ages 1-6

Exclusion Criteria:

- Non-English speaking primary caregiver

- Child with significant developmental delay